Tuesday, March 6, 2012

Guest Post: Nina's Birth Stories, part 2

As they wheeled me to the operating room, with what strength I had left, I just breathed. If
I have to do this, I have to do this, I thought to myself calmly. During the procedure, I was terrified.
They strapped my arms down and out, like a human letter T. The anesthesiologist informed me that
during the c-section, he would have to turn up the epidural, which would mean I would feel additional
numbness from below my ribs and down. While the surgery was being performed, I couldn’t help but
think that it felt like when I was a kid having my molars removed. Even though I was numb, I could still
feel pressure. It was …weird. And then I heard the cry.

Drew was beside me with tears of joy in his eyes. It’s a girl! I was relieved to hear that she
arrived safely. They brought her to me but I couldn’t hold her. My arms were numb and still strapped
down. I remember the friendly nurse brought Ripley close enough to brush against my cheek for our
first meeting. And then, they whisked her away.

My husband left to be with her, which I urged him to do while the rest of the staff prepared to close me up. As I lay there, I felt so tired. Any will power had been zapped. I started to feel heavy, like someone was sitting on my chest. And then I realized I couldn’t breathe. The numbness was creeping up my chest, across my breasts, engulfing me like a black shadow. I tried to speak to, but my words came out in a whisper. Large tears rolled down my face and I couldn’t stop them. I felt like I was drowning and no one knew it.

Suddenly, the anesthesiologist turned to look at me and asked, “What’s wrong?”

“I can’t breathe,” I whispered.

He didn’t hear me and had to lean down closer to me. With what remaining effort I had left, I
whispered more forcefully, “I can’t breathe.”

“Oh, I do have this turned up. I could turn this down a bit now.” He responded, ever-so
nonchalantly. I glared at him but he didn’t notice.

Ripley Anne Kim-Quy was born on February 3, 2009 at 8:54 PM. She weighed 7 pounds and 3
ounces and measured 20 inches long. And for two more hours after she was born, I did not hold her
simply because I physically could not. I drifted in and out of sleep as a result of the medications and
fatigue. I wanted to breast-feed her immediately but couldn’t even sit up. When I finally was able
to hold her and attempt breast feeding, I felt like I had rubber arms. The details of that night are still
foggy. It wasn’t until the next morning, when Drew left to go home and feed our cats that I was finally
alert, cognizant and alone with Ripley. I was able to finally absorb and understand the full extent of
her arrival, to become overwhelmed with joy, gratitude and love for this tiny being. I loved her with
my entire soul. It would take years for me to get over feeling robbed of this magical epiphany between
mother and child, even though it was merely hours lost.

When Ripley began walking at 16 months, I began to see her as a small person rather than a
baby. She understood what we said and could follow simple directions. I began to wonder about her
future, what kind of person she would become and how the people around her would come to shape
her. In the process, I began to reflect upon my own upbringing, having been raised as an only child, but
becoming close to my half-sister in adulthood. My sister-in-law came to visit one time, and as usual, my wacky in-laws were doing something unconventional. She gave my husband this knowing look, one in which only siblings could share and understand without saying a word. It was then we decided that we couldn’t let Ripley grow up alone.

However, there was just one big issue to deal with. Was I ready to have another c-section?

*********

At my post-partum visit following Ripley’s birth, the doctor that delivered Ripley informed me
that subsequent pregnancies would result in c-section deliveries, as it was the “policy of the practice.”
What did that even mean?

Around this time, I came across a book review in the Washington Post about the history of
childbirth, called Birth: The Surprising History of How We Are Born by Tina Cassidy. The irony is that I hardly read the newspaper given my limited time and when I did, I usually didn’t read book reviews. But this one caught my eye. The article mentioned that the author was motivated to research this topic following her disappointment in the delivery and birth of her own child, via c-section. She could have been talking about me. And that’s how I became fixated on learning more about childbirth. I had wanted to put the past experience behind me, but now I realized I needed to understand my experience if I was to go through with another pregnancy and have a vaginal birth after cesarean (VBAC). Forget re-reading What to Expect When You’re Expecting, my reading list included Birth, and a few others:

Pregnancy the second time around was different on many levels. The first most obvious was
that I could not rest during my fatigue and nausea-ridden first trimester. I had a toddler now who
demanded my attention. With what remaining energy and time I had, I focused it on the end product,
delivering a healthy baby vaginally. Forget registering for baby items or getting the nursery ready.

After two visits at my OB/GYN group practice that had delivered Ripley, I made the decision to
switch to a midwife practice. That last visit made all the difference. In meeting their newest associate,
I asked her numerous questions about a VBAC. When I asked her about my chances of having a
successful VBAC, she tried to change the terminology and explained that it would be a “trial of labor.” I was clearly irritated. I didn’t want a chance to try, I wanted to succeed. Finally, after pushing her to give me an answer, her best guess was a “50, maybe 60 percent chance.” No way, those odds were way too low for me. I’d be better off playing roulette at this point given her hesitation. I switched to a midwife practice that was still affiliated with the same hospital where I had delivered Ripley.

I don’t know if anyone else experiences this, but when I start to do internet research, I
sometimes find myself feeling overwhelmed by so much information that it's not clear which way
to go and now I am further confused and frustrated. Luckily, I took a chance and emailed Cheryl, a
doula I found online who seemed local to my area. We met and hired her to become my doula. Cheryl
was the coach I needed to help me train for this marathon I had never run. She was the event planner
for a wedding I never had. As someone who has personally delivered six times and attended over 200
births, she is fully aware of the intricate process of labor and delivery. We met several times over the
course of the pregnancy. She asked me many questions, forcing me to think through various scenarios,
to understand the medical and technical aspect of how the hospital and nurses operate and lastly, to
create a birth plan.

A birth plan? This seemed silly to me. I knew what I wanted. From my research and reading, I
wanted a natural birth. Intervention leads to more intervention to even further intervention, resulting
in a c-section. It seemed to me, Ripley’s delivery was classic, the result of one intervention (Stadol)
leading to another intervention (epidural) combined with another (pitocin) resulting in an abnormal
fetal heart rate until the final intervention (c-section). I wanted a vaginal birth for several reasons. I
wanted to recover quickly from the delivery because not only would I have a newborn to care for, I also still had my toddler at home. People often say, what you want is a healthy baby, but what I wanted was a healthy family, baby and me included! Cheryl, my doula, understood what I wanted, but it was the process of writing it down that was important. This forced me to understand all aspects of labor and delivery, especially technical aspects in which I could have a choice in the hospital setting. One strategy was to avoid the hospital as long as possible once labor began so the process can occur on its own, away from potential hospital interventions. This would allow me the opportunity to be comfortable in my own home, eat and walk as I pleased, and use our Jacuzzi-like bath tub.

As an aside, we never considered a home birth as an option. We were not comfortable should
a complication arise during labor and delivery, namely a ruptured uterus. We felt that the distance
between our home and the hospital was too great. The midwifery practice had a birthing center in
the building that was connected to the hospital by a tunnel, but my past history of a previous c-section
made me ineligible according to their practice policies. So it was back to the hospital for the delivery,
but this time I prepared. I studied as if it was an examination. I trained like it was a marathon.

3 comments:

Having the right people around you during labor can make all the difference! I wanted a natural birth for all the reasons you listed and read/watched many of the books/documentaries that you listed above.

My son, feeling very cozy, was 10 days past due when we induced. He had consistently measured big (via fundal measurements and ultrasound). I was using a midwife practice for a hospital birth and thanks to living in a crunchy-hippie-natural community, the hospital had more liberal policies. (I could eat, walk around, didn't have to have IV fluids.)

They turned the pitocin up after every 30 minutes (in hindsight too fast) and after a slow start, my contractions became intense and on top of one another. Finally unbearable, I asked for a spinal block. I had to get IV fluids, get in bed, and labor/push on my back.

It was the midwives who, despite the interventions, got me to my vaginal delivery. I am convinced, that after 3 hours of pushing and my son's heart rate dropping, that if I had been in any other hospital or hadn't been with my midwives (I had 2 at the birth) that I would have had a C-Section. They called the OB-Gyn on call, but she just supervised, and allowed us to continue.

This was very much a story of one intervention leading to another. Induction and an extremely aggressive use of pitocin made contractions that never seemed to stop, as well as added stress to my son. It pushed me to ask for pain meds, because there was literally no break between contractions, not even 10 seconds, and I had been laboring like that for hours. It all led to his heart rate fluctuating.

Those midwives saved my birth. More than anything, I tell moms to make sure they are familiar with labor and birth, the medical terms and options in a given situation, the hospitals policies and their wishes. Despite all of that, the most important part is having someone you are comfortable with there - either your doctor, midwife, or a doula.